Objective To review low-voltage versus high-voltage electrical burn complications in adults, and to identify novel areas that are not recognized to improve outcomes. Methods An extensive literature search on electrical burn injuries was performed using OVID Medline, PubMed and EMBASE databases from 1946–2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Results Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. 18.0% of these patients were low-voltage injuries (LVI), 38.3% high-voltage injuries (HVI) and 43.7% with voltage not otherwise specified (NOS). Forty-four percent of studies did not characterize outcomes according to low versus high-voltage injuries. Reported outcomes include surgical, medical, post-traumatic, and other (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI compared to LVI. Only two studies report on psychological outcomes such as post-traumatic stress disorder. Mortality from electrical injuries are 2.6% in LVI, 5.2% in HVI and 3.7% in NOS. Coroner’s reports reveal a ratio of 2.4:1 for deaths caused by low-voltage injury compared to high voltage-injury. Conclusions High-voltage injuries lead to greater morbidity and mortality than low-voltage injuries. However, the results of the coroner’s reports suggest that immediate mortality from low-voltage injury may be underestimated. Furthermore, based on the data of this analysis we conclude that the majority of studies report electrical injury outcomes, however, the majority of them do not analyze complications by low versus high voltage and often lack long-term psychological and rehabilitation outcomes post-electrical injury indicating that a variety of central aspects are not being evaluated or assessed.

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Atherosclerotic plaques are distributed differently in the aortic arches of C57BL/6 (B6) and 129/ SvEv (129) apolipoprotein E (apoE)-deficient mice. It is now recognized that hemodynamic shear stress plays an important role in the localization of atherosclerotic development. Since the blood flow field in the vessel is modulated by the vascular geometry, we quantitatively examined the difference in the aortic arch geometry between the two corresponding wild-type mouse strains. The three-dimensional (3-D) geometry of fourteen murine aortic arches, seven from each strain, was characterized using casts and stereo microscopic imaging. Many geometric features, including aortic arch shape, vessel diameter, and branch locations were significantly different at p<0.05 between the two mouse strains. Based on the geometry of each cast, an average 3-D geometry of the aortic arch for each mouse strain was obtained, and computational fluid dynamic calculations were performed in the two average aortic arches. Lower shear stress was found at the inner curvature of the aortic arch in the 129 strain, corresponding to greater involvement in the corresponding apoE-deficient mice relative to the B6 strain. These results support the notion that heritable features of arterial geometry can contribute to individual differences in local susceptibility to arterial disease.

Blockade of VEGF receptor 2 activation by tumor-derived VEGF decreases tumor vessel function and growth of some human pancreatic adenocarcinoma cell lines in mice.

A comprehensive approach to perioperative and intraoperative patient care has allowed outpatient abdominoplasty to be safely performed without VTE chemoprophylaxis in patients with fewer than six risk factors.

This study provides clarity regarding which procedures plastic surgery experts deem most important for preparing graduates for independent practice. The list represents a snapshot of expert opinion regarding the current training environment. As our specialty grows and changes, this information will need to be periodically revisited.

Background: Plastic surgery residency training programs are working toward integrating competency-based education into program curriculum and training, a key component of which involves establishing core procedural competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established core procedural competencies. Methods: A retrospective review of case log procedure data using three databases (T-Res, POWER, and New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004 and 2014 was completed. Case logs were coded according to 177 core procedural competencies identified as “core” by the Delphi method among an expert panel of Canadian plastic surgeons. Results: A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004 and 2014 (average, 1080 ± 352 procedures per resident). Of 13 plastic surgery domains, 44 percent of all procedures were within either hand, upper extremity, and peripheral nerve (28.3 percent) or nonaesthetic breast (16.1 percent). The most frequently performed core procedural competencies (average case logs per resident) included breast reduction (65.3 ± 33.9); open carpal tunnel release (46.7 ± 34.2); breast reconstruction, implant-based (39.6 ± 20.5); and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including escharotomy, temporal parietal fascia flap, Guyon canal release, and soft-tissue fillers. Conclusion: This study identifies areas of exposure and underexposure to plastic surgery core procedural competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition.

Background North American residency programs are transitioning to competency-based medical education (CBME) to standardize training programs, and to ensure competency of residents upon graduation. At the centre of assessment in CBME are specific surgical procedures, or procedural competencies, that trainees must be able to perform. A study previously defined 31 procedural competencies for Aesthetic Surgery. In this transition period, understanding current educational trends in resident exposure to these aesthetic procedures is necessary. Objectives To characterize aesthetic procedures performed by Canadian Plastic Surgery residents during training, as well as to describe resident performance confidence levels and degree of resident involvement during those procedures. Methods Case logs were retrieved from all ten English-language Plastic Surgery programs. All aesthetic procedures were identified, and coded according to previously defined Core Procedural Competencies (CPCs) Aesthetic domain of Plastic Surgery. Data extracted from each log included the procedure, training program, resident academic year, resident procedural role, and personal competence. Results From July 2004 to June 2014, 6,113 aesthetic procedures were logged by 55 graduating residents. Breast augmentation, mastopexy, and abdominoplasty were the most commonly performed CPCs, and residents report high levels of competence and surgical role in these procedures. Facial procedures, in particular rhinoplasty, as well as non-surgical CPCs are associated with low exposure and personal competence levels. Conclusions Canadian Plastic Surgery residents are exposed to most of the core aesthetic procedural competencies, but the range of procedures performed is variable. With the implementation of CBME, consideration should be given to supplementation where gaps may exist in aesthetic case exposure.